WASHINGTON, D.C. – Today, during a hearing of the Senate Committee on Health, Education, Labor and Pensions Committee (HELP), U.S. Senator Jacky Rosen (D-NV) questioned Dr. Ashish Jha, Dean of Brown University’s School of Public Health; Dr. Jerry Abraham, Director of Kedren Health Vaccines; Dr. Umair Shah, Washington State Secretary of Health; and Dr. Mary Ann Fuchs, Vice President of Patient Care & System Chief Nurse Executive at Duke University Health System about improving vaccine delivery and access, and increasing access to and investment in effective therapeutics to treat COVID-19. A transcript of the Senator’s full exchange can be found below, and a video of the Senator’s full exchange can be found here.
ROSEN: It is encouraging to see that 92 million Americans getting vaccinated, about 856,000 so far in Nevada. But greater access to the vaccine cannot come soon enough, far more needs to be done. Despite our progress, there have been challenges with appointment scheduling systems, long lines, too many individuals in underserved areas and rural communities being left out. Many Americans are still awaiting their first or second shot, as we know that the virus variants continue to mutate. It’s critical we rapidly review what’s working and make changes to ensure no one is left behind.
Dr. Jha, from a broad, systemic perspective, what do you see as the long-term changes we need to do to improve vaccine delivery, especially to our most vulnerable communities? And then, I think part of this would be to address our public health infrastructure, our data systems, our creative ways to reach people where they are at, regardless of their communities. What else can we do to help you with this?
JHA: Great. So let me kind of lay out what I think we know nationally, and then folks like Dr. Shah can talk about individual state level experience. When we look across the country, we see a lot of variation. Some people doing very well, some states doing very well. Other states struggle, and if you look at what differentiates states that are doing well from those that are struggling, keeping things very simple is probably the most important. A lot of states, I think, have made this far too complicated, and have made it very difficult for people to sign up, to arrive at a vaccination place, and the more difficult we make it, the harder we make it for people with fewer resources, fewer capabilities, fewer support systems to actually make it through this system. So, we really have to have a ground game where we go out to people, we make this incredibly easy. So, we’ve heard some of this from Dr. Abraham, what he’s doing in LA. But, it has got to be much more about getting out in to the communities and I worry a lot about the rural areas of the United States, because I just feel like we have not paid enough attention to how we’re going to get vaccines out there.
You know, the problem here is we’re trying to recreate a public health system that we have hollowed out over the last decade. And now, we find ourselves saying “Boy, it’d really be useful if we had a system that had good data, that had a really terrific workforce, that we could plug into.” But we don’t. So, we’ve got to build it for the short run because vaccines are a short-term problem, we’ve got to get people vaccinated quickly. But then we’ve got to make sure we don’t pull all those investments away once people are vaccinated, and say “Okay, we’re done we’re leaving.” We’ve got to leave a lot of those resources and infrastructure behind, not just for future pandemics, but for all the other health crises – opioids, other things that continue to plague our nation. We’ve got to continue to make investments in those. So, I’m hoping that vaccines become really the step that we need to leave a public health infrastructure that helps us address all sorts of public health challenges.
ABRAHAM: Senator Rosen, I just wanted to add really quickly -- Dr. Abraham here -- the digital divide in America, the digital fortress we’ve created as barriers to people and their vaccines, we really need to transform some of the digital demons that have stole [sic] grandma’s shot and train them, and teach them, and empower them to be digital angels that actually help us use these systems. These technologies are supposed to help us, not harm us, not stand in the way between people and their vaccines. And, we need to understand why we need this data, and there may be more creative ways to capture it than having a 65+ senior in our community fighting with their computer so they can get a vaccine.
ROSEN: I couldn’t agree more. I just have a few seconds left, so I want to talk quickly about therapeutics research and access. We know that we have vaccines, but people still become ill. What suggestions do you have to improve access to COVID-19 therapeutics for our vulnerable patients, maybe particularly in rural areas or in our areas that are underserved, with folks not able to get to a Tier I hospital perhaps? That’s going to become our challenge now as people become vaccinated.
JHA: Let me start by saying we do a lot of things well, and I think the scientific community has been extraordinary, the NIH has been extraordinary, but I would say that therapeutics is one area where we probably have underinvested.
And, I think there is a variety of issues – and we’ve done pretty well with in-patient therapies, we’ve got monoclonal antibodies, but they need out-patient infusion which is very difficult in a lot of contexts. We actually are underusing them, and I think given the billions of dollars, appropriately invested in vaccines, I would like to see a similar effort for therapeutics.
The virus is not going away, even when most of us have gotten vaccinated. We’d like to get to a point where, if you got infected, you could take a five or seven day oral course of something which would dramatically reduce your chances of getting sick. We don’t have that. We got distracted with things like hydroxychloroquine and all that stuff. We’ve got to let science drive this, and we’ve got to let the NIH, really get them a lot more resources to push new therapies. We don’t know which ones are going to work, but we’ve got to put a lot more effort into this area.
SHAH: The other thing I would say is we have to support our rural systems, to Dr. Jha’s point, with the rural hospitals, rural health care providers, rural health departments that are doing just an incredible amount of work, both on the vaccine side, but also on the therapeutic side. We just need to make sure we continue to support them because they face challenges that are quite different than anything in the – to be frank – urban areas. We need to make sure that we’re also thinking about those in a very methodical way.
FUCHS: I would also add that different innovative models of care delivery are really important. So, the work that has gone on about hospital-at-home programs are being able to deliver services from an enhanced home care perspective is some of the work that we have done in our health system, and we have seen the ability to treat people at home versus bringing them into the hospital.
So, these therapeutics, I think, have to be available to be able to be delivered in multiple places. Like for example, we believe we can deliver remdesivir in the patient’s home. We’re not able to do that right now because of the restrictions around it. So, we have to think creatively about how we can deliver care differently to be able to touch the people wherever they are, and especially in our rural communities.